Provider Demographics
NPI:1235563453
Name:PATTERSON, MELDONIQUE
Entity Type:Individual
Prefix:
First Name:MELDONIQUE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OVERLOOK RIDGE DR
Mailing Address - Street 2:APT. 212
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1123
Mailing Address - Country:US
Mailing Address - Phone:617-820-6741
Mailing Address - Fax:
Practice Address - Street 1:11 OVERLOOK RIDGE DR
Practice Address - Street 2:APT. 212
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1123
Practice Address - Country:US
Practice Address - Phone:617-820-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool